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Subscriber's Statement of Claim |
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American Specialty Health (ASH) – Subscriber Claim Form |
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Out of State Claim Form (Travel Reimbursement) | Download | |
Out of State Claim Form | Download | |
Authorization for Release of Personal and Health Information |
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Download |
Prescription Drug Reimbursement Form |
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Blue Shield Global Core International Claim |
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Proof of Death Form: Group Life |
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Accelerated Death Benefit Claim Form: Group Life |
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Dismemberment Claim Form: Group Life |
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Dental Claim |
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Vision Claim |
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Waiver of Premium Claim Form: Group Life |
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Beneficiary Affidavit & Assignment Form |
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Beneficiary Change Request |
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Contact Us
Producer Services (800) 559-5905
Employer Services (800) 325-5166
Blue Shield of California
PO Box 272540
Chico, CA 95927-2540
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Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Health plans are offered by Blue Shield of California.